SECTION 2
Client Care and Service
Community Focused
Continuing Care
Emergency/Trauma
Maternal, Child & Youth
Medical Care
Mental Health
Palliative Care
Specialized Intensive Care
Surgical Care

SECTION 3
Support Services
Information Management
Human Resources
Physical Environment

SECTION 4
Leadership/Partnership
Strategic Directions
Implementing Strategic Directions

The joint physician and administrator leadership are very strong in this team. The combined manager position for emergency and intensive care support strong linkages between these departments.

A space planner is assisting in evaluating the functionality of the department in relation to volume and client needs. Psychiatric nursing hours have been expanded and programming continues to be developed to better meet the needs of this client population A number of the initiatives are in place to avoid unnecessary emergency visits and admissions. These include the quick response program, a congestive heart failure clinic in medical day care, and additional support for oxygen and intravenous therapy in long term care facilities. Also, the home intravenous therapy program has been expanded to include CAD pumps.

Formal and informal referral networks are established and include an emergency referral form for clients being sent by general practitioners and the medical clinics. A trauma referral service and standardized triage process are in place to ensure quick access and assessment for these clients. Clinical consultants are accessed as required. A clinical resource nurse position is being established to assist with ensuring consistency in quality of care and service.

Nurses communicate with clients and families and provide orientation on an ongoing basis. Informed consent processes include implied, written, and full explanations regarding tests, invasive procedures, blood products, and any studies that are under way. Intervention education is offered and clients and families are given a choice in this regard. A wide range of informative handouts and instructional pamphlets are available. The pharmacist will assist where necessary. Other disciplines such as the social worker, psychiatry and home care assist with discharge planning as required.

Documentation of assessment and history is completed on an emergency out-patient record. Support is given to a multidisciplinary out-patient record currently under consideration. There is good interdisciplinary collaboration. The trauma team is notified in advance of client arrival. There is 24-hour access to a central poison control centre.

There is some use of clinical practice guidelines. Thrombolytic therapy is incorporated into standing orders. Inclusion and exclusion criteria have been developed. Door to needle time is monitored. A conscious sedation protocol is in place. Standard height and weight scales are used for management of podiatric cases. A common intravenous health record has been developed for the home therapy program.

Quality improvement initiatives are ongoing, for example, the paper flow task team and the triage action committee. The team is recognized for condensing the original list of improvements into a concise quality strategic plan. A comprehensive list of indicators is being developed and these will be used to monitor the priorities selected for improvement. Efforts to capture emergency out-patient CIHI data will also be pursued. The 24-hour unit clerk is a new initiative and this will assist with consistent data collection.

Risks are well managed. The team views wait times for both triage and admission an ongoing concern and believes that electronic processes would prove beneficial. Encouragement is offered to formalize referral networks with other organizations regarding ambulance redirects or diversions and critical care bypass situations. There is also a need to address privacy for clients who are being triaged and for those who are waiting on stretchers.

Maternal, Child and Youth Services

In addition to maternal and newborn care and services that include parenting classes. youth services are offered and include speech, audiology, dental health, and counseling. Illness prevention and health promotion activities are offered to both population groups.

There is a broad referral network which includes community health centres, schools, nutritionists, social workers, community development workers, individual families and youth, midwives and physicians. Effort is made to minimize duplication and the process for follow up of discharges is perhaps an area that requires attention. Although interdisciplinary collaboration is extensive, there is some confusion and possible duplication around post partum follow up. Currently, new mothers may see a community or hospital nurse, their family physician or midwife immediately after discharge and, in this time of strained resources, clarification is required in order to reduce duplication and allow for better utilization of human resources.

Commendation is given for working toward an integrated system that will include all levels of care as well as emphasize promotion and prevention particularly for youth. Education programs are prominent and provided through lectures, pamphlets, brochures and one to one teaching. Also recognized is the concerted effort to ensure that community health centres offer services that meet local needs, such as youth drop in clinics, parenting classes, et cetera. It is suggested that the maternity program has an opportunity to develop a new focus by reviewing its current range of traditional services.

Good processes are in place for maintaining client records in both the institution and community setting. Client records for youth services include a complete assessment that involves family members and liaison with schools as necessary. There are community health plans in place for care at home and at school to meet chronic care needs of children and youth. There is a perceived need, however, to improve services for children with psychiatric needs. Discussions between mental health services and the maternal child program will hopefully improve access to appropriate psychiatric services.

The team has selected its priorities for improvement and intends to review these for appropriateness. The development of indicators is a work in progress. Currently, it would appear that the results of improvement initiatives are communicated only within the program. (See Recommendation 5, page 25.) The team has identified a potential risk concerning the service to children in the emergency department because the facility is not “child friendly” and it is suggested that present planning to address this be continued.

Recommendation:

1. Clients sign a general consent on admission, however, there is no written consent for invasive procedures such as induction or caesarean section. This constitutes a risk and it is, therefore, recommended that current practice be reviewed and that a process be developed and implemented to ensure written and informed consent to specific procedures. (See Draft Standards for Comprehensive Health Services, 1997, Maternal/Child Care, 4-4.3.)